What are the International Consensus Report recommendations for the workup of immune thrombocytopenia (IPT) in adults?

Updated: Jan 11, 2020
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Basic evaluation in all patients should consist of the following [40] :

  • Patient history
  • Family history
  • Physical examination
  • CBC and reticulocyte count 
  • Peripheral blood film
  • Quantitative Ig level measurement
  • Blood group (Rh)
  • HIV serology - Recommended by the majority of the panel for adult patients in the appropriate geographic setting
  • Hepatitis C virus serology - Recommended by the majority of the panel for adult patients in the appropriate geographic setting 
  • Hepatitis B virus serology

Tests of potential utility in patients with ITP include the following:

  • Glycoprotein-specific antibody (can be used in difficult cases, but has poor sensitivity and is not a primary diagnostic test)
  • Antiphospholipid antibodies (including anti-cardiolipin and lupus anticoagulant) if there are clinical features of antiphospholipid syndrome
  • Anti-thyroid antibodies and thyroid function
  • Pregnancy test in women of childbearing potential
  • Antinuclear antibodies (ANA) – A positive ANA may be a predictor of chronicity; hydroxychloroquine may be an effective treatment if ANAs are present, especially in young women; ANA testing can be considered before splenectomy because of the increased risk for thrombosis
  • Polymerase chain reaction (PCR) testing for Epstein-Barr virus, cytomegalovirus, and parvovirus
  • Bone marrow examination (may be informative in patients with systemic symptoms, abnormal signs, or with suspicion of a different diagnosis)
  • Direct antiglobulin test Helicobacter pylori testing (should be considered in adults with typical ITP, in those with digestive symptoms, and those from areas of high prevalence)

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